THE RELATIONSHIP BETWEEN CLINICAL-TRIALS AND CLINICAL-PRACTICE - THE RISKS OF UNDERESTIMATING ITS COMPLEXITY .1. CONCLUSIONS

Two main points are addressed in the following remarks. The first is t hat the survival of randomized clinical trials (RCTs) as the gold stan dard by which to assess the effectiveness of medical technology is bei ng seriously challenged. It is incumbent upon methodologists and clini cal researchers to understand why this is happening and commit themsel ves to improving the process through which new possibilities for impro ved treatments are selected, prioritized and implemented. The second p oint is that trialists should abandon the idea that the availability o f relevant information is a sufficient condition for a timely and wide spread acceptance of RCTs results. Contrary to what health services re search has repeatedly indicated, trialists still, by and large, seem t o believe in a simplistic model that assumes a one-way linear and rapi d relationship between scientific knowledge and clinical practice. In the concluding section the paper pinpoints some issues to be further d iscussed from the point of view of monitoring and conducting trials.